Monday, December 16, 2013

Dr. ER: "I have a 20-something guy here, who a few hours ago abruptly became paralyzed from the waist down, with severe lumbar pain. He can't move his legs at all. I sent him for a STAT MRI, which was normal, and..."

Dr. Grumpy: "Does he have reflexes?"

Dr. ER: "Yeah, and sensation is good, too. But he can't move either..."

(yelling, screaming, swearing in background)

(pause)

Dr. ER: "Ibee, are you still there?"

Dr. Grumpy: "Yeah. What was all that noise?"

Dr. ER: "Never mind... When we refused to give him more Dilaudid he just got up and walked out. He's gone."

Fakers are so common in ERs the nurse bloggers ("Madness") are always writing about them. I would think most ERs could smoke them out without resorting to an MRI. Wouldn't the knee reflex be sufficient?

This basic idea constitutes about 10% of all the mystery cases on "Untold Tales of the E.R.," which is a fun show to watch if you like that sort of thing.

The most recent one I recall was a nearly identical case except that the patient claimed to have no sensation - to the point where when the ER doc jammed a syringe into his foot, he didn't respond!

However, when the "million dollar workup" showed no physical problems and he was denied narcotics, he wheeled himself out in a hospital wheelchair - then got up, snuck back in, stole a lab coat, and went foraging for drugs. When he was seen on monitors security went after him and he led them a merry chase through the entire hospital.

The best part was that during his apprehension, he put up such a fight that his femur was badly fractured, but they figured he was faking again and almost sent him back to the jail like that. Fortunately the doctor realized just in time that he really was hurt, and he *finally* got his Dilaudid.

Once had a guy tape a little pebble to his back hoping it would show up on the KUB as a kidney stone. After telling us all how allergic he was to iodine/contrast etc... he thought he had it made in the shade until we told him we'd send him for a non contrast CT. It showed the stone outside the skin.... When confronted he got up and left.

No, the truly imaginative work the specialists (as one did when I worked for a pain doc), have him/her send them to the ER due to "excruciating pain" (so much so that they have to be wheeled out doubled over in a wheelchair), then they get the Dilaudid in the ER and literally, stroll on out according to the note.

Needless to say, he only did that once. Not your typical drug seeker profile, either.

Just please don't smear all of us who go to the ER for narcotics with the same brush! I'm one of those misfortunate people who live with a migraine 24/7 and don't respond to typical migraine meds or toradol, a favorite of ER doctors. So occasionally I do end up in Emergency because I'm in so much pain I'm ready to commit suicide to escape it. And as much as I wish non-narcotic medicines would help me, wishing doesn't make it so, and I do need morphine. There are actually a fair number of people with chronic migraine, but the growing concern about fakers who are just looking for drugs has meant that I leave the hospital, which has all my medical recordsits computer for all to see that I'm a legitimate migraine patient, in as much pain as when I went in!

Taping a pebble to the back is a new one, wow. Addiction is a sad and terrible thing. I'm a domestic violence advocate at a DV shelter and we see addicted clients use the ER to get their narcotics, even having us call 911 for them so they can take an ambulance and get their meds. I often pull aside one of the paramedics to a. Apologize for having to send for them for a non emergency, b. Advise them of client Hx. I only do this with the ones I know really are drug seekers, they usually are going to hospital and urgent cares several times a week. I do recognize the difference between a chronic medical pain issue and a drug seeker. I am a person who suffers from chronic debilitating migraines, however, am blessed with a great pain management Dr. And a supportive husband. I haven't had to go to the ER for migraine in probably 3yrs. My pain management doc does a great job of keeping my pain managed without over medicating.

Med seekers ruin it for everyone who truly has chronic pain. Vicki- ever tried Topomax? Or Botox injections? Probably not. Morphine feels better. I'm the first one to admit that when my back is acting up I wish I had something stronger than Tramadol- but I want to save all of that for when I'm old and REALLY in pain.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

Have Dr. Grumpy delivered automatically to your Kindle for only 99 cents a month! Sign up here!

Dr. Grumpy is for hire! Need an article written (humorous, medical, or otherwise) or want to commission a genuine Grumpy piece for your newspaper/magazine/toilet paper roll? Contact me to discuss subjects. You can reach me at the email address below, or through my Linked-In profile.

Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.